Strength and Perseverance - UT Medical Center · 2019. 6. 24. · football player, to wheelchair basketball, he tried it. Mack found he loved its energy and camaraderie so much that

Our Mission | To serve through healing, education and discovery

Strength and Perseverance2018 Trauma Report

The University of Tennessee Medical Center’s Level I Trauma Center works daily to advance trauma care in East Tennessee

and beyond. As the only Level I Trauma Center to receive verification from the American College of Surgeons in our region,

we are committed to performing at the highest level of care for our patients and their families. We offer comprehensive

care, beginning with the first responders and continuing after discharge with physical therapy, support services such

as the Trauma Survivors Network, and other vital resources. Our hard-working and humble providers are committed

to the best outcomes for our patients, regardless of their ethnic background, gender or social situation. This report

acknowledges the Emergency & Trauma staff and their unwavering dedication to their community.

Brian J. Daley, MD, MBA, FACS, FCCP, CNSP

Professor, Department of Surgery

Program Director, General Surgery

Chief, Division of Trauma and Critical Care

Department of Surgery

Niki Rasnake BSN, RN, CEN

Trauma Program Manager

Acknowledgments

2

2018 Trauma Report

Table of ContentsAcknowledgments ............................................................................................................................................................... 2

A Survivor’s Story ...................................................................................................................................................................4

Living to the Mack(s) ...........................................................................................................................................................6

Supporting the Superheroes ..............................................................................................................................................8

Trauma Survivors Network .................................................................................................................................................9

Leadership ............................................................................................................................................................................10

Trauma Surgeons .................................................................................................................................................................11

Pastoral Care ...................................................................................................................................................................... 12

Stop the Bleed ..................................................................................................................................................................... 13

Admissions and Visits ........................................................................................................................................................ 14

Causes of Traumatic Injury ............................................................................................................................................... 15

Trauma Patients by County of Origin ............................................................................................................................ 16

Arrivals and Hospitalizations .......................................................................................................................................... 18

Trauma Center Statistics ................................................................................................................................................... 19

Patient Distribution ........................................................................................................................................................... 20

Patients 55 and Older........................................................................................................................................................ 21

Trauma Services Program Staff ......................................................................................................................................22

Injury Prevention ................................................................................................................................................................ 24

Tragedy Brings New Life ...................................................................................................................................................25

Donating the Gift of Life ...................................................................................................................................................26

Facts and Figures ...............................................................................................................................................................27

Trauma Alert Activation ....................................................................................................................................................28

Auto-Acceptance Guidelines ...........................................................................................................................................29

TEE Up for Trauma ............................................................................................................................................................. 30

Guardian Angel ................................................................................................................................................................... 31

3

Strength and Perseverance

4

“I know more about gunshot wounds than I ever knew was possible,” said Jimmy Smith, 48, of Knoxville.

Three years ago, while standing in front of his apartment with his brother, Jimmy was shot 11 times in the arms, legs and abdomen.

Paramedics rushed him to the Emergency Department at The University of Tennessee Medical Center, where doctors immediately wheeled Jimmy into surgery. The trauma was so extensive — a shredded colon, a hole in the stomach, a broken pelvis, and more — the medical team didn’t think he would survive the night.

They induced a medical coma and called his family, telling them to come to the hospital. “My mom refused to believe it,” said Jimmy. “She told the doctors, ‘My son hasn’t made it this far to die now.’”

That faith, Jimmy believes, is what got him through that night and the next 13 months of grueling surgeries and rehab.

Gunshot Wounds on the Rise

According to statistics from the Centers for Disease Control, in the United States, about 300 people a day sustain a gunshot wound. Between 10 and 30 percent of these people will die of their injury, the highest mortality rate since 1968.

A Survivor’s StoryJimmy Smith, shot 11 times, offers hope to other shooting victims.

Jimmy Smith’s faith, and the support of family and peer visitors, helped him recover.

“My mom refused to believe it,” said Jimmy.

“She told the doctors, ‘My son hasn’t made it this

far to die now.’”

2018 Trauma Report

5

Statistics from The University of Tennessee Medical Center show gunshots are now the third-highest mechanism of injury in our region in two age groups, children aged 0-13 and young adults, aged 18-25. They follow only motor vehicle crashes and other blunt mechanisms in the first group, and motor vehicle crashes and falls in the second.

This makes gunshot wounds one of the top traumas handled at The University of Tennessee Medical Center. It also means more gunshot survivors than ever need someone to talk with about their experience — someone who’s been there.

Giving Back to Other Gunshot Survivors

While he was in the hospital, Jimmy received visits from peer visitors with the medical center’s Trauma Survivors Network. “My family, while big, couldn’t be with me every day. Just when I’d be feeling blue,” he said, “here would come a peer visitor to lift my spirits.”

Jimmy wanted to return the favor. “I was so blessed,” he said. “I wanted to give back something of what they gave me.”

Now, when someone comes to the hospital with a gunshot wound, Jimmy listens to them, and tells them about his experience. “I can use my knowledge to help them understand what they’re going through and to show them there’s hope.”

Doctors initially thought Jimmy would be in the hospital for extensive period of time, that he would be unable to walk and that he would wear a colostomy bag for the rest of his life. Jimmy beat the odds in every case, going home after 13

months, walking with only the help of a cane or crutches, and living colostomy-free.

Jimmy’s story of hope helps other survivors see a way through their traumatic experience.

Now, Jimmy stays busy with his grandchildren and visiting his peers at the medical center. He’s even started looking for a part-time job.

“I’m grateful for every day,” he said. “And for my family and my friends at the medical center for getting me through.”

Jimmy Smith visits with gunshot survivor Arvenzio Miles.

The Healing Power of Sharing

Jimmy is such a kind-hearted spirit. Through his visits with other gunshot survivors he offers comfort, developing a strong bond of friendship with the patients and their families.

He always makes himself available to visit with the patients, whether in person or over the phone. Jimmy helps trauma patients feel reassured and hopeful.

Therese A. Zaltash, M.S.Trauma Survivors Network, Clinical Coordinator


6

Living to the Mack(s)Mack Johnson’s courage and humor help him give hope to other trauma survivors and their families.

Mack Johnson is a junior in accounting at Auburn University and a member of the Auburn Wheelchair Basketball team.

2018 Trauma Report

7

In 2016, Mack Johnson, 19, fell off a cabin balcony in Gatlinburg. He was flown to The University of Tennessee Medical Center, where doctors told him he was paralyzed from the waist down. He spent nine days in intensive care at the medical center. “Once I realized the gravity of what had happened,” Mack said, “I was like, how am I going to get through life?”

While at the medical center, Mack learned how to function in a wheelchair, making transfers from bed to chair, and sitting up for increasingly longer periods of time.

When the medical center released him, Mack traveled to the Shepherd Center in Atlanta, where he spent three months rehabilitating. At Shepherd, Mack learned how to live independently.

During rehabilitation, it became apparent that remaining active would keep him physically and emotionally strong. “Exposure to a variety of activities is crucial throughout therapy,” said Mack.

So when Shepherd introduced Mack, a former high school football player, to wheelchair basketball, he tried it. Mack found he loved its energy and camaraderie so much that he joined Shepherd’s team.

“I had never been exposed to the world of adaptive activities,” said Mack, “ and it was good therapy for me to have an activity I enjoyed, even though it was different or adaptive.” Now, the accounting major, a junior at Auburn, plays with the Auburn Wheelchair Basketball team. “They’re the center of my support network,” he said.

Mack’s support system also includes The University of Tennessee Medical Center’s Trauma Survivors Network. As a peer visitor for the program, he talks with other trauma survivors, using his sense of humor to put them at ease.

“When you meet people, at first, they see you as your disability. If you can laugh at your own situation, they’re more

comfortable being around you, because they know you’re comfortable with yourself.”

Mack visits with his peers in Knoxville, via phone and Facetime from the Auburn campus. “Just keeping in touch is so big. Doctors are great, but they give you typical answers. You want to talk to someone who’s been there.”

He encourages other trauma survivors to keep an open mind and try new things. “If someone offers me an opportunity to do something new, I take it,” he said. As a result, since his injury, he’s tried tennis, surfing, cycling and water skiing.

But the most exhilarating experience Mack has had since his injury is skydiving. Two years after he fell, Mack and his friends jumped from a plane flying at 14,000 feet.

“I fell from something higher than that balcony and survived”.

Mack, on a recumbent bike, has been an athlete his whole life.

“If someone offers me an opportunity to do something new, I take it”.


8

Team BUSAR’s motto, “Be the Superhero,” is more than just words on their website. The members of Team BUSAR (which stands for Backcountry Search & Rescue) donate their time, and often use their own equipment, searching for and rescuing lost people in the National Park System including the Great Smoky Mountains National Park. The team has been awarded funding from the Robert F. Lash Endowment Fund three years in a row.

Team BUSAR board member, Jeanna Beck, said, “The Robert F. Lash Endowment Fund has been incredibly supportive of Team BUSAR. In the last three years, we received funds that provided satellite communicators, Gore-Tex jackets, and helmets designed for professional rescue.”

Given the hypothermic conditions, poor visibility and steep terrain that the team often encounters during rescues, this equipment has ensured the safety and comfort of the team’s 20 volunteer responders.

“From a safety perspective,” said Matt Jernigan, assistant team leader, “this was tremendous.”

Grant-Funded Equipment Helps the Rescuers

Andrew Herrington, the driving force behind Team BUSAR, started the organization four years ago, after working as a law enforcement ranger and seeing how challenging it can be to staff rescue efforts. He put together a team of outdoor

athletes including climbers, adventure racers, paddlers and other people with extensive outdoor experience to supplement the parks’ search and rescue efforts. Their role is to supplement and assist rangers with the most arduous missions in the Park.

In 2018, this translated to more than 5,000 hours of grueling team training and active missions. “In the past two years, we’ve been involved in several extensive searches and many carry outs,” said Jernigan. That included the search for Susan Clements, a missing hiker from Ohio and Austin Bohanan, a teen that went missing in the Smokies for 11 days, and was later found by boaters on Abrams Creek.

Winning the Robert F. Lash Endowment Fund hasn’t just helped Team BUSAR. It’s also changing safety culture in the National Parks.

“Climbing across rough country in thick vegetation puts our teams in danger, but few people were wearing helmets,” said Jernigan. “So when we got ours, Park team members followed suit.”

About the Robert F. Lash Endowment Fund

During his nearly 20-year career with The University of Tennessee Medical Center, Robert F. Lash, MD, served in many roles. Considered by many as an pioneer for emergency medicine, Lash established UT LIFESTAR, one of the first air ambulances

in the United States, and served as its first director.

In addition, he brought a poison control center to the medical center and was responsible for leading the effort to create the UT Family Medicine Department where he served as the first chair.

The Robert F. Lash Endowment Fund supports annual educational programs related to emergency medicine and pre-hospital care.

To find out how you can apply for a Robert F. Lash Endowment Fund, contact Sharon Layne at 865-305-6359. To learn more about Team BUSAR, visit teambusar.org.

Supporting the SuperheroesHere’s how the Robert F. Lash Endowment Fund helped Team BUSAR, a local search and rescue group, expand their rescue capabilities.

2018 Trauma Report

Team members during winter training.

9

The Trauma Survivors Network (TSN) is a community of patients and families who are looking to connect with one another and rebuild their lives after a serious injury.

TSN Programs at the Medical Center:Peer Visitation: Former trauma patients and caregivers are trained to be peer visitors. Peer visitors volunteer their time to visit patients and their families in the hospital and share experiences from the road to recovery after a serious injury. Peer visitors can answer your questions from the perspective of someone who has been there. This year we began incorporating phone peer visits to provide support for patients who have been discharged.

Survivors, Support Group, Let’s CHAT: This is a general support group for trauma survivors that is held the first Tuesday of the month from 6-7:30 pm.

Snack & Chat: Family and friends of patients currently admitted to our Trauma Center are invited to take time to relax, have a snack and learn more about the emotional impact of trauma. The group meets once a week in the Trauma Surgical Intensive Care Unit on Tuesdays at 2 pm. Mobile snack and chat occurs at 10 am on Thursdays on 5, 7 and 10 East to serve visiting family and friends.

IPad lending: TSN has iPad’s available to inpatient trauma patients. They can be checked out for one day at a time.

For more information about TSN programs please contact the TSN Coordinators at 865-305-9970, [email protected], or visit traumasurvivorsnetwork.org

Trauma Survivors Network


2018 Stats96 Patients

1,333 Patients

95 Peer Visits

TSN’s outpatient support group, Let’s Chat, averaged 8 participants per meeting, or about 96 patients per year.

TSN Coordinators supported 1,333 patients with 29 percent receiving follow-up visits. During the initial visit patients and their families are given the Trauma Patient Handbook, a brochure about the TSN program and any resources or information the patient may need support with.

95 peer visits occurred during 2018. Peer visitors dedicated over 120 hours to the TSN program and conducting peer visits.

10

Leadership

Brian J. Daley, MD FACS, MBA, FCCP, CNSPMedical Director

Karen Pryor, MSN, RN, CNMLDirector of Emergency & Trauma Services and Critical Care

Blaine L. Enderson, MDMBA, FACS, FCCMVice President of Emergency& Trauma Services and Critical Care

Neurocritical CareJ. Russell Langdon, MDMedical Director andVice President, Brain & Spine Institute

Medical Critical CareJames E. Shamiyeh, MD MSPH, FCCPCo-Director

Paul R. Branca, MDFCCP, D-AABIPCo-Director

AcknowledgmentsDe partment of Oral and Maxillofacial Surgery Department of Radiology Department of SurgeryDivision of Plastic Surgery Neurosurgical AssociatesUniversity AnesthesiologyUniversity General SurgeonsUniversity Orthopaedic SurgeonsTEAMHealthUT LIFESTARPastoral Care

Trauma Services

Reagan W. Bollig, MDMedical Director

Trauma Surgical Critical Care

2018 Trauma Report

11

Reagan W. Bollig, MDMedical Director

Trauma Surgeons

Trauma Multidisciplinary Liaison TeamA multidisciplinary trauma peer-review committee was formed to include liaisons from all the subspecialty groups that are involved in trauma care. This committee meets monthly to review all aspects of trauma care, including systematic review of all mortalities, significant complications and process variances associated with unanticipated outcomes. Our goal is to improve patient care, including prehospital care, acute care issues, post-discharge requirements as well as outreach and injury prevention.

J. Michael McCoy, DDSTraumaOMFS* Liaison

J. Doug Keller, DOTraumaAnesthesia Liaison

William E. Snyder, Jr., MDTraumaNeurosurgeon Liaison

Brian M. Tonne, MDTraumaOrthopaedicSurgeon Liaison

Anneliese Cuttle, MDEmergency DepartmentMedical Directorand Trauma Liaison

Steven P. Knight, MDTraumaRadiology Liaison

*Oral and maxillofacial surgery

Reagan W. Bollig, MD

C. Lindsay McKnight, MD

Brian J. Daley, MD,FACS, MBA, FCCP, CNSP

Todd A. Nickloes, DO, MBA, FACOS, FACS

Marc A. Campbell, DO,FACOS

R. Frank Roberts, MD, FACS

James W. Goodin, MD, FACS

Lou M. Smith, MD, FACS


12

Pastoral CareChaplains are an integral part of the care team at The University of Tennessee Medical Center. Our spiritual care delivery process is one of the first in the nation to be recognized with the HealthCare Chaplaincy Network’s Excellence in Spiritual Care Award. Chaplains respond to the needs of our medical center 24/7.

We are dedicated to providing spiritual counseling to the medical center’s trauma patients. We demonstrate this by meeting every trauma patient and their family and guests, and caring for their spiritual needs. We are with them from the Trauma Bay until they leave the hospital.

CPE Training Our medical center has the region’s only accredited training center for Clinical Pastoral Education (CPE). Our Trauma Center offers the student and resident chaplains real-life experience to integrate their theological education in a clinical setting.

As a training program, our CPE supervisors and staff chaplains are constantly working towards the best holistic care for our customers. Our program also allows students and residents to grow these skills in an educational environment.

15 on the 15th In 2016, we announced an initiative called, “15 on the 15th,” aimed at supporting our Emergency Department and Trauma staff. On the 15th of every month we offer a 15-minute coffee break with the chaplain.

While we are always available for their team, we have found this intentional, standing break has become a celebrated time to get to know each other better. Many of those conversations have led to supportive relationships that enhance the value of the medical center culture.

Sacred Moments in the Midst of Chaos The Level I Trauma Center and Pastoral Care Department work together to find sacred moments in the chaotic experience of injury, treatment and recovery.

We are not always aware of the impact we have, but sometimes we are reminded in the most moving of ways. Last spring a hand-written note showed up in the chapel. The writer told a personal story of hope and survival. It was written on the anniversary of an overwhelming and frightening night.

Half of his family had nearly died in a car accident and he had found comfort in our chapel. “Most of the time,” he wrote, “I couldn’t even form the words — I just cried big, ugly, scared tears.” In that moment, a stranger came in and offered to pray with him. “When I opened my eyes,” he said, “she was gone.”

The note went on to say many times he has prayed for our medical center and the people who find themselves in similar situations. And folded in the note was a five dollar bill. The money was meant to buy a cup of coffee for another person who might find their way to the chapel afraid and overwhelmed. The note ended, “God’s Peace be with you.”

When I tell people that I am a chaplain at The University of Tennessee Medical Center, their response is often, “That place is like a whole city. I sometimes get lost over there.” Notes such as this one remind me of how lost some of our guests feel. And, notes such as this one, remind me of the hope we inspire by caring for our patients.

I gave the money to another father who needed a cup of coffee that very day. He had been up all night with his family, praying. I’ve kept the note and I often end chapel services with the author’s hopeful words, “God’s peace be with you.”

By Brad Hood, Chaplain

The Pastoral Care staff, left to right: Coy Callicot, Brad Hood, Randy Shoun, Steve Sexton, Benjamin Lewis, George Doebler, Heather Shirey, Lisa Casey and Anne Sprouse

2018 Trauma Report

13

Stop the Bleed

The Stop the Bleed campaign was officially launched by the White House in October 2015. This campaign is part of the Presidential Policy for National Preparedness. The policy addresses building national resilience through public awareness, education and training.

In aid of this policy, and supported by the American College of Surgeons, the medical center began offering The Bleeding Control Basic Course in April 2017.

This course recognizes that citizens may be faced with a life-threatening bleeding situation at any time. Massive bleeding from any cause — but particularly from an active shooter, explosive event or natural disaster where a response is delayed — can result in death.

Victims can die from uncontrolled bleeding within five minutes. According to the National Trauma Institute, 35 percent of prehospital deaths are caused by traumatic injury, hemorrhage or major loss of blood. In the same way the general public has learned CPR, medical organizations must also teach people to recognize life-threatening bleeding and apply proper bleeding control techniques.

Bleeding Control Basics Course

In the Bleeding Control Basics Course, attendees learn to apply direct pressure, pack wounds and apply tourniquets.

The course is taught to all age groups with no pre-existing medical knowledge required. Designed as a one-time certification, this course provides the knowledge and skills to help save a life. Through these courses, the trauma staff has found attendees also gain confidence and lose their fear of doing something wrong.

As a Level I Trauma Center, our injury prevention and outreach initiatives encompass the East Tennessee region. Since the launch of our Stop the Bleed initiative, we have held 138 courses and trained over 3,182 individuals. We have also recruited 250 additional instructors from health care, EMS services and law enforcement. Partnering and collaborating with agencies throughout our region has brought unity to the program offerings.

One main goal of the Stop the Bleed campaign is to place bleeding control kits in public locations, such as schools, churches and businesses. Through efforts like these, we are striving to bring this life-saving training to everyone in our region.

TIMEWIND SECUREWRAP

CALL 911

1 APPLY PRESSURE WITH HANDS

2 APPLY DRESSING AND PRESS

The ‘Stop the Bleed’ campaign was initiated by a federal interagency workgroup convened by the National Security Council Staff, The White House. The purpose of the campaign is to build national resilience by better preparing the public to save lives by raising awareness of basic actions to stop life threatening bleeding following everyday emergencies and man-made and natural disasters. Advances made by military medicine and research in hemorrhage control during the wars in Afghanistan and Iraq have informed the work of this initiative which exemplifies translation of knowledge back to the homeland to the benefit of the general public. ‘Stop the Bleed’ is a registered service mark of the Department

of the Defense. Use of the equipment and the training does not guarantee that all bleeding will be stopped or that all lives will be saved.

3 APPLY TOURNIQUET

© 2017 American College of Surgeons

For more information: UTMedicalCenter.org/stopthebleed

A student in a Bleeding Control Basics Course learns to apply a tourniquet.

By Gigi Taylor, Trauma Outreach Coordinator and Debi Tuggle, Injury Prevention/Pediatric Trauma Coordinator


14

8000

7000

6000

5000

4000

3000

2000

1000

02009 2010 2011 2012 2013 2014 2015 2016 2017 2018

TOTAL VOLUMETOTAL ADMITSTrauma Volume and Admissions Per Year

Emergency Department Patient Volumes by Month

On-Call Specialists

Top 3 Groups Receiving the Most Consults

Specialty Consultations Operations

OMFS* 1076 779

Neurosurgery 1766 663

Orthopaedics 2839 1870

As a Level I Trauma Center, the University of Tennessee Medical Center is required to have general surgeons, Emergency Medicine physicians, Intensive Care physicians and anesthesiologists in-house at all times. Other specialists and a full range of equipment must also be available 24 hours a day, 7 days a week, 365 days a year.

8000

7000

6000

5000

4000

3000

2000

1000

0Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

*Oral and maxillofacial surgery

Emergency Department Patient Daily Volumes by Month

300

200

100

0Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Admissions and Visits

2018 Trauma Report

15

Causes of Traumatic Injury

Injuries blunt vs penetrating

Top 3 Mechanisms of Injury by Age GroupAge 0-13 14-17 18-25 26-45 46-65 >65

#1 Motor VehicleCrash

Motor VehicleCrash

Motor VehicleCrash

Motor VehicleCrash Falls Falls

#2 Other BluntMechanism Falls Falls Falls Motor Vehicle

CrashMotor Vehicle

Crash

#3 Gunshot All-TerrainVehicle Gunshot Motorcycle

CrashMotorcycle

CrashOther BluntMechanism

All Level I trauma centers are required to admit at least 1,200 trauma patients yearly or admit 240 with an Injury Severity Score of more than 15. The injury severity score (ISS) is a scoring system that applies a numerical value to a patient’s anatomic injuries.

In 2018, the Trauma Service at The University of Tennessee Medical Center admitted 930 patients with Injury Severity Scores greater than 15, which is almost four times the national requirement for a Level I Trauma Center.

Injury Severity Score Trauma Patient Distribution by Injury Severity Score

ISS Number of Patients

Minor <8 1440

Moderate 8-15 1927

Serious 16-24 772

Severe 25-40 297

Critical-Maximum 41-75 31

Causes of traumatic injury


51% Falls

23% Motor Vehicle

9% Other

6% Motorcycle

3% Gunshot

3% Assault

3% ATV

2% Pedestrian

1% Stab Wound

92% Blunt

7% Penetrating

1% Other

16

Shelby

McNairy

Maury

Benton

Robertson Sumner Clay

Overton Fentress

Putnam

WhiteCumberland

Rhea

RoaneLoudon

BlountSevier

AndersonKnox Jefferson

Hamblen

Meigs

McMinnMonroe

HamiltonBradley Polk

Morgan

Scott CampbellUnion

Claiborne

Grainger

HancockHawkins

Greene

Washington

Sullivan Johnson

Carter

Unicoi

Cocke

Bledsoe

Davidson

Williamson Rutherford

Warren

Wilson

Tipton

Fayette

LaurderdaleHaywood Madison

Chester

Hardin Wayne

Decatur

Perry

Humphreys

Houston

Stewart Montgomery

Dickson

Cheatham

Hickman

Lewis

Lawrence

Giles Lincoln

Marshall

Moore

Bedford

Trousdale

Macon

Jackson

Pickett

Smith

Dekalb

VanBuren

Cannon

Coffee

FranklinMarion

SequatchieGrundy

HendersonCrockett

Dyer

ObionWeakley Henry

CarrollGibson

Lake

Hardeman

2

2

2

1

1

1

1

1

1

1

11

11

1

28

1

15

138

1321

154151

371303

1360 165

152

166

104161

54

67 12050 58

8613

5

19

6

15

1

100

6

2

111

7

3

3

4 4

Referring HospitalsBig South Fork Medical Center 93

Blount Memorial Hospital 238

Claiborne Medical Center 55

Cumberland Medical Center 167

East Tennessee Children’s 2

Fort Loudon Medical Center 68

Fort Sanders Regional 77

Medical Center

Hancock County 2

Jamestown Regional 29

Medical Center

Jefferson Memorial 93

Jellico Community 44

Johnson City Medical Center 10

LaFollette Medical Center 72

Lakeway Regional 28

Laughlin Memorial 10

LeConte Medical Center 201

Methodist Medical Center 129

Morristown-Hamblen 110

Healthcare System

Newport Medical Center 97

North Knoxville Medical Center 82

Parkwest Medical Center 171

Physician’s Regional 73

Medical Center

Rhea Medical Center 3

Roane Medical Center 84

Starr Regional Medical (Athens) 74

Starr Regional Medical (Etowah) 19

Sweetwater 126

Takoma Regional Hospital 3

Turkey Creek Medical Center 28

Wellmont Bristol Regional 2

Wellmont Holston Valley 2

Kentucky hospitals 102

North Carolina hospitals 3

Virginia hospitals 1

2018 Trauma Report

17

Shelby

McNairy

Maury

Benton

Robertson Sumner Clay

Overton Fentress

Putnam

WhiteCumberland

Rhea

RoaneLoudon

BlountSevier

AndersonKnox Jefferson

Hamblen

Meigs

McMinnMonroe

HamiltonBradley Polk

Morgan

Scott CampbellUnion

Claiborne

Grainger

HancockHawkins

Greene

Washington

Sullivan Johnson

Carter

Unicoi

Cocke

Bledsoe

Davidson

Williamson Rutherford

Warren

Wilson

Tipton

Fayette

LaurderdaleHaywood Madison

Chester

Hardin Wayne

Decatur

Perry

Humphreys

Houston

Stewart Montgomery

Dickson

Cheatham

Hickman

Lewis

Lawrence

Giles Lincoln

Marshall

Moore

Bedford

Trousdale

Macon

Jackson

Pickett

Smith

Dekalb

VanBuren

Cannon

Coffee

FranklinMarion

SequatchieGrundy

HendersonCrockett

Dyer

ObionWeakley Henry

CarrollGibson

Lake

Hardeman

2

2

2

1

1

1

1

1

1

1

11

11

1

28

1

15

138

1321

154151

371303

1360 165

152

166

104161

54

67 12050 58

8613

5

19

6

15

1

100

6

2

111

7

3

3

4 4

Trauma Patients’ Home StatesAlabama 24

Arkansas 3

Arizona 3

California 5

Colorado 2

Delaware 1

Florida 71

Georgia 50

Iowa 2

Illinois 22

Indiana 28

Kansas 1

Kentucky 301

Louisiana 7

Massachusetts 1

Maryland 4

Michigan 23

Minnesota 4

Mississippi 8

Missouri 7

North Carolina 73

Nebraska 2

Neveda 1

New Hampshire 1

New Jersey 3

New Mexico 4

New York 4

Ohio 30

Oregon 1

Pennsylvania 9

South Carolina 25

South Dakota 1

Tennessee 6,037

Texas 12

Utah 2

Virginia 28

Washington 1

Wisconsin 5

West Virginia 8

Trauma Patients by County of Origin


43% Ambulance 8% Private Vehicle

37% Referring Hospital 3% Other Helicopter

9% UT LIFESTAR

18

Arrivals and Hospitalizations

Disposition after leaving Emergency

Department

1684

1896

1815

1993

1864

3700

3296

2919

2882

2474

2009

2010

2011

2012

2013

UNITS OF BLOOD USED

2014

2015

2016

2017

2018

2018 Trauma Report

36% Floor

32% Home

18% ICU

12% OR

2% Transfer

1% Death

Transport from scene of injury

to hospital

19

Trauma Center Statistics

Trauma Patients Distribution by Age

Financialdistribution

The Trauma Service at The University of Tennessee Medical Center provided uncompensated care to over 996 severely injured patients in 2018. The average gross charges for each of these cases was $35,025.

Dischargedestination

1 14 18 26 36 46 56 66 75

108771166559442046239110729


43% Medicare

14% Medicaid/TN Care

11% BlueCross BlueShield

8% Self Pay

8% Auto

7% Commercial

4% Other

3% Workers’ Comp

1% Military

1% HMO/PPO

57% Home

22% Nursing Home

9% Home Health

5% Death

4% Other

2% Rehab

1% Long Term Acute Care

500

450

400

350

300

250

200

150

100

50

0

20

119

242

392

434

464

371

206

135

98

Patient Distribution

Patient Distribution by Month700

600

500

400

300

200

100

0

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

468

417

493

605

682

637651 648

607 617

502 503

Patient Distribution by Hour of Day

7A 9A 11A 1P 3P 5P 7P 9P 11P 1A 3A 5A

Patient Distribution By Day of the Week

44%

Female56%

Male

956MONDAY

933TUESDAY

955WEDNESDAY

936THURSDAY

1001FRIDAY

1068SATURDAY

987SUNDAY

Gender Distribution

2018 Trauma Report

21

Patients 55 and Older People aged 55 and older are the fastest-growing segment of the population, as the Baby Boomers age and enter their “golden years.” This has resulted in a steady increase in trauma-related admissions in this population. Consistent with patterns across the nation, at The University of Tennessee Medical Center falls are now the leading cause of unintentional injury in the older adult population, accounting for nearly 60 percent of the admissions. Numerous studies show an increased death and disability in older adult trauma patients when compared to a younger population; therefore, it is imperative for older adults to be rapidly transported to a trauma center — ideally during the first hour.

Injury Severity ScoreAge 55 and Older

ISSNumber of

Patients

Minor <8 750

Moderate 9-15 1228

Serious 16-24 409

Severe 25-40 146

Critical-Maximum 41-75 8

Injurydistribution: patients

55 and older

5000

4000

3000

2000

1000

02009 2010 2011 2012 2013 2014 2015 2016 2017 2018

TOTAL ADMITS 55 OR OLDERTOTAL TRAUMA ADMITSPercentage Admissions 55 or Older

34% 37% 38% 40% 46%47% 49% 49%54%

57%

1% Gunshot

1% ATV

1% Assault

71% Fall

16% Motor Vehicle

7% Other

3% Motorcycle

42% Home

36% Nursing Home

11% Home Health

5% Death

3% Other

2% Rehab

1% Lo ng Term Acute Care


Dischargedestination

Trauma Services Program Staff

22

2018 Trauma Report

Trauma Program ManagerNiki Rasnake, BSN, RN, CENThe trauma program manager is fundamental to the development, implementation and evaluation of the Trauma Program. In addition to administrative responsibilities, the trauma program manager must show evidence of educational preparation, certification and clinical experience in the field of trauma care. Key responsibilities include: organization of performance improvement activities; management of the trauma registry; and coordination of outreach education and injury prevention activities at the community, state and national levels. The trauma program manager is also involved with research, analysis and facilitating protocol development within the trauma program. The trauma program manager represents the trauma program on hospital and state committees to enhance trauma care delivery and management for our patients.

Injury Prevention/Pediatric Trauma CoordinatorDebi Tuggle, RN, CENThe injury prevention/pediatric trauma coordinator is instrumental in the development, implementation and evaluation of the pediatric trauma service and injury prevention in our community. Key responsibilities include: coordinating pediatric trauma performance improvement programs and participating in education and outreach programs, including injury-prevention programs. The injury prevention/pediatric trauma coordinator represents the pediatric trauma service on hospital committees and represents the medical center on community and state committees.

Trauma Performance Improvement CoordinatorKelly McNutt, BS, RN, CEN, TCRNThe trauma performance improvement coordinator’s primary responsibility is to monitor and continually improve structures, processes and outcomes within the institution in collaboration with the trauma medical director and trauma program manager. Other duties include trauma registry data validation and generation of performance reports. The reports generated support a number of functions, including performance improvement activities; development of research projects for publication and presentations at national meetings; and providing information to support legislative and educational initiatives, which impact the safety of our community. The trauma performance improvement coordinator collaborates with the multidisciplinary team in the daily care of trauma patients to enhance continuous quality improvement for the trauma program.

Trauma Outreach CoordinatorGigi Taylor, MSN, RN, TCRN, CENThe trauma outreach coordinator plays a significant role in assuring that the Trauma Center serves as a community and regional resource. Outreach programs are an integral part of Trauma Center services. These programs are designed to help improve outcomes from trauma and prevent injury through public and professional dissemination of information, and the facilitation of access to the clinical and educational resources of the Trauma Center. The components of an outreach program may include public awareness, injury prevention education or professional education. The scope of education and outreach programs depends on a variety of factors for the region, including the needs of the region as well as available resources.

Brief Intervention CoordinatorKayla Aloisi, LMSWThe brief intervention coordinator is the newest position in Trauma Services. The brief intervention coordinator is responsible for Screening Brief Intervention and Referral to Treatment (SBIRT) program. Key responsibilities include: conducting drug and alcohol assessments and providing brief interventions to trauma patients that screen positive for risky behavior, build and maintain partnerships with area treatment programs and to follow up with trauma patients who were referred to a treatment program. The brief intervention coordinator also works with the trauma clinic to collect Post-traumatic stress disorder (PTSD) screens and follows up with those who screen in a high range to provide information and resources.

TRAUMA REGISTRARSThe trauma registrar is an integral member of the Trauma Center. Trauma registry data is abstracted and entered by the trauma registrar. Trauma registry data is used internally in the continuous performance improvement process at the medical center. Data is reported to the National Trauma Data Bank and the Tennessee State Trauma Registry. High-quality data begins with high-quality data abstraction and entry — it is the trauma registrar who performs this task and then analyzes the data and prepares it for distribution in its most useful format.

Becky A. Kali, RHIT, CPC, CSTRLead Registrar

Mandi Finchum, RHIT

Linda Bushong, RHIT

Jan Ely

Jennifer King

Vicki Harness Traonna Smith,RHIT

Karen Jenkins

23

TRAUMA SURVIVORS NETWORKThe Trauma Survivors Network (TSN) is a national program developed by the American Trauma Society. It helps trauma patients and their families connect with one another and rebuild their lives after a serious injury. The TSN coordinators at the medical center act as a liaison for patients and their families, introducing them to the program and giving them access to resources aimed at helping them rebuild their lives. The TSN is a free service to trauma survivors and their families.

TSN CLINICAL COORDINATORTherese Zaltash, MSThe TSN clinical coordinator serves as a point of contact for program participants, office and clinical support personnel. Key responsibilities include: facilitating educational and support groups, coordinating outreach and educational efforts, and educating the hospital staff about the program. The clinical coordinator trains and manages TSN volunteers as peer visitors and community educators. The clinical coordinator recruits trauma survivors for support group and the peer visitation program.

TSN DEVELOPMENT COORDINATORElizabeth Waters, LAPSWThe TSN development coordinator is responsible for submitting and managing grant proposals for foundation and corporate sources. Key responsibilities include: coordinating day-to-day operations of the TSN program with the clinical coordinator; creating and maintaining database information for program evaluation and reporting; and co-facilitating the Survivor Support Group with the clinical coordinator. The TSN development coordinator also serves as a field instructor for social work students who provide support to the TSN and other Trauma Center initiatives.


Injury Prevention

Though it may be unintentional, injury does not occur by accident. Trauma Centers have an important role in identifying injury patterns and risk factors in patients, families and communities. For many injuries, prevention is the best means of dealing with a public health problem.

Protective Equipment Saves LivesUse of protective equipment has been proven to increase survivability if you are involved in a crash. At the medical center, we treat many patients that do not use protective equipment when driving or participating in recreational activities. Over 70 percent of the patients involved in motor vehicle crashes were wearing seatbelts at the time of their accident.

An alarming number of ATV enthusiasts do not wear a helmet while riding; only 12 percent of the riders admitted to the Trauma Center were wearing a helmet when their accident occurred.

Motorcyclists are more likely to wear a helmet when they are involved in a collision; after all it is the law. However only 79 percent of the motorcyclists were helmeted, leaving room for improvement.

Injury Does Not Occur by Accident

24

Seat Beltusage by adults

Helmetuse by ATV riders

79% No Helmet

12% Helmet

9% Unknown

70% Seatbelt Used

22% Unrestrained

8% Unknown

Helmetuse by motorcyclist

79% Helmet

10% No Helmet

8% Protective Clothing

4% Unknown

2018 Trauma Report

25

79% Helmet

10% No Helmet

8% Protective Clothing

4% Unknown


“Jenni was a very special person — someone you could count on,” said Jenni’s father, Bernardo Orive. This proved true after a car crash took Jenni Fuentes’ life, because she saved the lives of four others through organ donation.

On July 14, 2018, Jenni attended a gathering of family and friends. On her way from the party, she lost control of her car and crashed. Family members saw her wreck and pulled her to safety as the ambulance arrived. She was rushed to The University of Tennessee Medical Center’s Level I Trauma Center.

Family and friends set up a vigil in the Trauma Center waiting room. Over the next week, her health declined, and her doctors confirmed she would not recover. The family discussed Jenni’s wishes to be an organ donor. After deciding to direct donate, or give Jenni’s organs to specific recipients, they asked those at the vigil to recommend potential recipients.

Tragedy Brings New LifeJenni Fuentes was killed in a car crash, but she lives on with organ donation.

Out of three names given, two were matches. One recipient was registered as number 559 on the national list through the medical center. Science teacher Dr. Marcus Randolf had just learned the devastating news that his girlfriend, who was a match for a kidney donation, had developed a kidney stone and wouldn’t be able to donate.

Less than a week later, he heard he would receive a kidney from Jenni. He said, “I am grateful beyond words for this chance, and yet so sorrowful for the Orive family’s loss.”

Jenni brought so much joy to everyone’s life, and continues to do as she lives on through organ donation.

26

Donating the Gift of Life

An Extraordinary Commitment to Science, Health and HopeTennessee Donor Services (TDS) serves nearly five-and-a half million people in Tennessee and Southwest Virginia. We are a team of professionals dedicated to saving and improving lives by connecting organ and tissue donors with patients who need them. We strive to extend the reach of each generous donor’s gift to those who are profoundly grateful for them.

Core ValuesOur performance is measured by the impact we have on the lives of families who make transplantation possible, and the patients whose lives are saved and improved by their gifts. Each TDS employee commits every day to be: • Selfless • Hardworking • Passionate • Dependable

donatelifetn.org

2018 Trauma Report

Our WorkWe are proud of our partnership with The University of Tennessee Medical Center. Our work together in 2018, resulted in 29 organ donors with 112 lifesaving organ transplants. In addition, the medical center also had 58 tissue donors in 2018.

Marcus’ sister, Christi Kirk, worked with Jenni after she arrived in Knoxville from Mexico City, Mexico. Christi said that Jenni’s life goal was to be a registered nurse because she wanted to help people.

Even in death, Jenni was able to help people, changing four lives through organ donation.

In addition to the kidney donated to Dr. Randolph, Jenni’s other kidney was donated to an 18-year-old man who is a senior in high school. Her liver went to a 52-year-old assistant principle who pastors part-time, and her heart was given to a 33-year-old woman. Their surgeries went well, and they are all recovering fully.

In August 2018, Jenni’s family attended the medical center’s monthly flag ceremony wearing matching t-shirts to honor her. This ceremony is held monthly, honoring those who have given and received the gift of life.

For more information about this ceremony or organ donation, please contact Tennessee Donor Services at 888-234-4440 or [email protected].

27

Facts & Figures

114,000

305

36,500

people are currently waiting for a lifesaving organ

patients are currently waiting in Tennessee

patients are currently waiting for a kidney transplant at The University of Tennessee Medical Center

52

18

patients received kidney transplants at The University of Tennessee Medical Center in 2018

transplants take place each day in the United States, on average

Person is added to the waiting list every 10 minutes

Lives that can be saved through one person’s organ donation


3,030organ transplants

occurred in the United States last year

20patients die every day waiting for a lifesaving transplant

95

28

Trauma Alert ActivationTrauma alert activation is assessed as Emergency Medical Service crews transport patients to the Trauma Center and they communicate patient information to the Emergency Department. This vital on-scene information allows the activation of one of our three-tiered trauma team responses. Levels of activation are determined by the local, state or American College of Surgeons field triage criteria, and applied based on the medical condition of the patient. Once the trauma team is activated, a multidisciplinary team unites and awaits the injured patient’s arrival to ensure rapid evaluation and treatment.

TRAUMA ACTIVATION CHART

Call per EMS radio or UT LIFESTAR of incoming trauma

Full Alert/Modified Alert/Trauma Consultactivation per trauma pagers

EDE – Emergency Department Evaluation

Emergency physician evaluates and determines need for trauma consult or appropriate service consult. May discharge patient after evaluation

if minor or no injuries sustained.

Decision made:admit/operating room/discharge

Decision made:admit/operating room/discharge

DISCHARGETrauma ConsultResident on call paged

to evaluate patient in ED

TRAUMA ALERT?YES NO

Trauma Team Activation

• Attending surgeon• Trauma residents• Trauma response • RNs• Lab• ED tech• Pastoral Care• Pharmacy• CT scan/X-ray ready • Respiratory therapy• 4 units emergency

release blood at bedside

Trauma Team Activation

• Attending surgeon• Trauma residents• Trauma response • RNs• Lab• ED tech• Pastoral Care• Pharmacy • CT scan/X-ray ready

Resident Paged

Resident on call paged to evaluate patient transferred from outside facility with single-system injuries

FULL ALERT MODIFIED ALERT TRAUMA CONSULT

Activations

2018 Trauma Report

48% Modified Alert

38% Trauma Consult

14% Full Alert

29

NOTE: • All acceptance criteria are affected by and may differ when medical center in-patient beds are at capacity.• Trauma patients can be auto-accepted with partial workups when a major life-threatening injury is identified (e.g., head

bleed) and/or with obvious injury (e.g., obvious fractures, paralysis on clinical exam) and/or with hemodynamic instability identified early in the initial resuscitation at the referring facility. Patient should be stabilized according to transfer requirements as capable at referring facility.

• Call UT LIFESTAR at 865-305-9112 for connection to appropriate admitting service or referral to Patient Placement Center.

This summary is intended to help emergency doctors and staff in understanding which patients can be automatically accepted, and when an attending physician must be involved in making the decision to accept or deny a transfer.

Auto-Acceptance Guidelines

ADULT TRAUMA (age 14 and older)Auto-accepted through UT LIFESTAR

FULL ALERT• Confirmed BP <90 at any time• Significant deterioration of previously stable patient• UT LIFESTAR patients requiring blood products to maintain

vital signs• Respiratory rate <10 or >29, or intubated due to respiratory

distress• Penetrating wounds in head, neck, chest or abdomen• Glasgow Coma Scale <_8, due to trauma

MODIFIED ALERT• Obvious long bone fractures,

proximal to the wrist/ankle• Flail chest• Pelvic fractures• Paralysis• Spinal fractures with signs and symptoms of

neurologic deficits or paralysis• Burns >15 percent total body surface area• Vascular injury proximal to wrist/ankle• Traumatic pneumothorax• Traumatic amputation proximal to wrist/ankle• Glasgow Coma Scale >8 but <13• >20 weeks gestation involved in a traumatic

incident• Fall >10 feet• Auto-pedestrian crash >5 mph• High-speed motorcycle crash estimated >40 mph• High-risk auto crash: MVC with co-occupant

death or ejection, high rate of speed (>_ 40mph), ejection from automobile/motorcycle/ATV without self-extrication, long extrication >_20 minutes

TRAUMA CONSULTSingle-system injuries including but not limited to:• Fractures from a ground-level fall• Rib fractures• Closed head injury with Glasgow Coma Scale 14

or greater• Spinal fractures without signs and symptoms of

paralysis, radiographic evidence of retropulsion or cord involvement

• Distal long-bone fractures, appropriately splinted and no neurovascular compromise

• Facial fractures (patient can protect airway and there is no active bleeding)

• Snakebite with envenomation

NOT auto-accepted: Single-system injury distal to ankle or wrist


30

2018 TEE Up for Trauma Golf TournamentBenefiting the Trauma Survivors Network

at The University of Tennessee Medical Center

Thank you to the event chair, David Sumilas, our corporate sponsors and more than 115 golfers in the community for supporting the region’s only Level I Trauma Center.

For more information regarding sponsorship opportunities, how you can get involved, or if you would like to donate in support of our Emergency and Trauma Center, please contact the Development Office at 865-305-6611 or by email at [email protected].

ADDITIONAL SPONSORS• BarberMcMurry Architects, LLC• CNL Healthcare Properties • First Tennessee Foundation• Hanger Clinic• The Hildreth Agency• LHC Group• MedFinancial• Med-Trans • Messer Construction• O’Neil, Parker & Williamson, PLLC• Pinnacle Financial Partners• Regions Bank• SunTrust• University Orthopedic Surgeons• Wakefield & Associates

EAGLE SPONSORS CART SPONSOR LUNCH SPONSOR

PAR3 SPONSORS

THE UNIVERSITY OF TENNESSEE MEDICAL CENTER

GuardianAngel

Who’s Touched Your Life Today?Make a gift in honor of a physician, faculty member, nurse, housekeeper or another caregiver who made a difference in your stay.

WHO made a difference?“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”– Maya Angelou

Our team members are dedicated to serving our patients and their families with care and compassion. If a doctor, faculty member, volunteer or other caregiver has made a difference in the care you or a loved one received, we encourage you to recognize and honor that compassion through our Guardian Angel program.

HOW to say thank you?Our patients often express their gratitude for the excellent care they received in a variety of ways—through kind words, smiles, letters of thanks and financial contributions.

By donating a minimum of $10, the team member that you choose to acknowledge will receive a notification of your honor and a custom-crafted guardian angel lapel pin to wear proudly throughout the medical center.

WHY is your support important?Acknowledging an individual for a job well done is one of the most meaningful forms of support you can offer. Your donation demonstrates an understanding of the important role our team members play in enabling us to continue fulfilling our mission of excellence in patient care, education and research.

THANK YOU!

Make A DonationVisit UTMedicalCenter.org to learn more ways to donate, or contact the Development Office

at 865-305-6611 or [email protected].

UTMedicalCenter.org/give-back/donate

ED0119001 EEO/Title VI/Title X/Sec.504/ADA

The University of Tennessee Medical Center is the home of the Knoxville campus of UT Graduate School of Medicine, UT College of Pharmacy and University Health System, Inc. Together, these entities embody the medical center’s philosophy and mission to serve through healing, education and discovery.

We Value Integrity • Excellence • Compassion Innovation • Collaboration • Dedication

UTMedicalCenter.org

Strength and Perseverance - UT Medical Center · 2019. 6. 24. · football player, to wheelchair basketball, he tried it. Mack found he loved its energy and camaraderie so much that

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